3 1 l98729ae3.htm FIRST CITIZENS BANC CORP/JAMES E. MCGOOKEY FORM 3 First Citizens Banc Corp/James E. McGookey Form 3
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

FORM 3

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940


1. Name and Address of Reporting
Person*
2. Date of Event Requiring Statement
(Month/Day/Year)
3. I.R.S. Identification Number of Reporting
Person, if an entity (voluntary)
  McGookey, James E.   12/02/02  
 
(Last)             (First)           (Middle)
 
 
  3221 Country Club Lane 4. Issuer Name and Ticker or Trading Symbol 5. Relationship of Reporting Person(s) to Issuer
    First Citizens Banc Corp (FCZA)   (Check all applicable)
 
(Street)
 
  [   ] Director [X] Officer (give title below)
    6. If Amendment, Date of Original
(Month/Day/Year)
  [   ] 10% Owner [   ] Other (specify below)
  Huron, Ohio 44839       SVP Legal Counsel
 
(City)                (State)            (Zip)
 
 
        7. Individual or Joint/Group Filing
(Check Applicable Line)
 
        [X] Form filed by One Reporting Person
[   ] Form filed by More than One Reporting
Person
   


 

FORM 3 (CONTINUED)


Table I — Non-Derivative Securities Beneficially Owned

1. Title of Security
(Instr. 4)
2. Amount of Securities
Beneficially Owned (Instr. 4)
3. Ownership Form: Direct (D)
or Indirect (I) (Instr. 5)
4. Nature of Indirect Beneficial Ownership (Instr. 5)

  Common 160   D    

  Common   160   I   spouse

               

               

               

               

               

* If the form is filed by more than one reporting person, see Instruction 5(b)(v).


 

FORM 3 (continued)
                           

Table II — Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

1. Title of
Derivative
Security
(Instr. 4)
2. Date Exercisable
and Expiration
Date
(Month/Day/Year)
3. Title and Amount
of Securities
Underlying Deri-
vative Security
(Instr. 4)
4. Conversion
or Exercise
Price of
Derivative
Security
5. Ownership Form
of Derivative Se-
curity: Direct (D)
or Indirect (I)
(Instr. 5)
6. Nature of
Indirect
Beneficial
Ownership
(Instr. 5)

      Date
Exer-
cisable
Expi-
ration
Date
 
Title
Amount
or
Number
of Shares
           

                           

                           

                           

                           

                           

                           

                           

                           

                           

                           

 

Explanation of Responses:

Late Filing-Time delay receiving EDGAR codes and ownership information.

/s/ James E. McGookey   February 6, 2003

**Signature of Reporting Person
 
Date

 
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
 
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
 
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.

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